Provider Demographics
NPI:1558433961
Name:HOMEPLACE OF BURLINGTON, LLC
Entity Type:Organization
Organization Name:HOMEPLACE OF BURLINGTON, LLC
Other - Org Name:HOMEPLACE OF BURLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-227-2328
Mailing Address - Street 1:118 ALAMANCE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5583
Mailing Address - Country:US
Mailing Address - Phone:336-227-2328
Mailing Address - Fax:336-227-2329
Practice Address - Street 1:118 ALAMANCE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5583
Practice Address - Country:US
Practice Address - Phone:336-227-2328
Practice Address - Fax:336-227-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-001-022310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803650Medicaid